So while I’ve gotten in the habit of Tweeting what comes to mind on Twitter @CWagon75, I still have quite a list of ideas and jotting down notes throughout my day, especially when I am reading or in class.
I’ll just make a few notes in Google Keep and then use that to trigger a few lines. I wind up deleting about 10% of the notes because whatever I wrote down, I just don’t remember the relevance.
The common theme topics seem to be Trigger Points, Pain Science, Training Outside of Neutral and principles of Andreo Spina’s FRC, and proper and complete utilization of the Functional Movement System, and High Performance Solutions.
Aside from the unique presentations of an isolated Trigger Point, it may in fact, not be isolated at all. In the presence of what is accepted as a TrP, there is an overall decrease in threshold depolarization of threat-messaging C-Fibers in a particular area. Boal and Gillete showed a change of -40mv to -70mv in the A-Delta and C- fiber sensitivity in the dorsal horn.
This in turn may very well explain a number of things ranging from fibromyalgia to legitimizing the systemic effects of what we see at the local milieu of TrP.
But of course we have some people saying Trigger Points aren’t real and others saying Trigger Point Dry Needling doesn’t work.
In studying what seems like any topic, one commercial model, with credibility and reasonable substance, will suggest one route. And another similarly credible model will say the exact opposite.
How can they both be right?
The way I see it, somebody has to be wrong. Some things are black and white, probably more than the suggestive non-confrontational ameliorating nature we are so impressed into acting upon.
I tend to think the better way is just ignore the idiots. I mean isn’t it just science that we will be desensitized to their crowing eventually.
So back to Trigger Points not being real, what exactly did Sikdar and Shah see under ultrasound?
If they’re not real and a North American cultural “thing,” then what are they, and why do they have these constant characteristics of tension and nociception?
Highly underrated = The Rule of the Artery; I hope to learn more osteopathic principles in the future.
If there is resting tension in a system that houses and constricts an artery, perhaps peripheral issues can be mitigated by releasing tension on the artery feeding its peripheral routes.
Treat tissues compressing an artery if there is pain. If it works, it was claudication, not mechanical or neuromuscular.
Treat tissues compressing a vein if there is swelling. This is magic when it works. Blown up ankle sprain can skip out. Meniscal surgery the next day did walking lunges out the door. I don’t know if he ever had surgery down the road.
Pulling the milieu of a TrP yields more acidic blood. Low blood pH is associated with hyperalgesia irrespective of the presence of TrP.
When I see this, I think through the message that at some point, the blood was becoming acidic causing muscle tension acutely before it became a chronic adaptation in the tissue as shown by Sikdar on Ultrasound.
Certain types of life processes remand acidic changes in blood, and increased intensity of training and sympathetic stressors do this as well. So if we have a very low lactic threshold by being terribly unfit and more activity or sooner during any given activity throws us to the lactic energy systems, we are more apt to developing to resting muscle tension and if continued chronic TrP.
So whether we see acidity in local humeral measures, or we see the value of fitness shifting threshold to the right, we can see that 2 worlds that seem very far apart are really all one in the same.
Again, I don’t believe everyone should do everything, but the manual therapy specialist can’t say that fitness isn’t part of the solution. And the ass kicking coach should realize that soft training and manual therapy can stave off the normal changes that result from serious training.
“There’s always a cost to doing business.” –Patrick Ward
I think we can cheapen the cost when we work in a team.
Given the semantics that make the most sense to me, no one is weak. No one is weak unless they can’t feed themselves or can’t raise up out of a chair even with leaning forward.
But what pains me is that most of the time when we see a Manual Muscle Test, it is for someone in pain or jacked up in some way. And if the performance on this test is not of some level of predetermination, the muscle is considered weak and then sometimes, not always, it is responded to with a plan of strengthening. Now if it is strengthening, it obviously has to be a certain level of heavy after the movement has been learned sufficiently. I’m not sure that the learning or the strengthening actually happens when the loads are so piddly when we have PTs that find it incumbent to fill up exercise sheets so Techs and high school volunteers can supervise clients after a 5 minute warmup on an arm or recumbent bike coaching “strengthening.”
But is the muscle weak when there is pain? Is the muscle weak because there is some form of threat leading to arthogenic inhibition? Is the muscle weak when the joint is stiff and doesn’t allow proper position for force production?
How does strengthening fit into any of these situations?
Muscles aren’t weak. There’s just varying levels of strong.
Systems can be inefficient which limits force production. Fix the system. Then retest force production.
Treating everything in the -tome just makes sense as per Chan Gunn.
Any peripheral input or afferent response has to go through the dorsal horn of the spine associated with that area of the body.
So if we treat other areas that can track back to that myotome, sclerotome, or dermatome, then we at least have reason to believe a retest of the target tissue to be favorable.
I think this can also track back to embryological development that demonstrates why some areas become affected despite not necessarily being local to the overt area of pain or tension.
So while much if not all of pain science is basically incontrovertible fact, do you know any ardent messengers of pain science that also talk about a systematic approach to make changes in an individual very quickly.
The evaluation process can simply be tracked back to a cost analysis of applying stressors to the system.
With this thought process, rationalizing any decision becomes individual, defensible to yourself, and fair.
I wonder if BioFlow Anatomy also tracks into BioFlow Physiology.
Can the purposeful soft tissue adaptations be reproduced under drastically different humeral environments?
Given what we’ve learned regarding acidic blood and local oxygen pressure and tissue tension, I think the answer is no. I don’t think motor skill acquisition or performance is the same under lactic conditions.
I think the bigger answer is keeping as many unique performances below threshold so the BioFlow Physiology is less variant.
Easier said than done I suppose.
We all have opinions based on the information we get exposed to.
The stronger the opinion, the closer we accept it fact.
Based off this combination of opinions and facts, we have beliefs.
Beliefs lead us to make statements.
Statements lead us to decisions.
Tracking back to all of these pit stops is the self-audit process that is the foundation of your system.
Because of course you have a system. :-/
If joints can’t get into the right position, you can not acquire new motor skills or develop resiliency to particular directions of tension.
It is always mobility before stability.
When you apply it correctly, I’d say 85% of any FMS-related question is ‘yes.’
When you apply the FMS correctly, anything fits into its principles. Anything.
Developing tension outside of joint neutral comes at a cost.
Particularly at the spine, if you train outside of neutral, there are very real concerns that are not up for debate.
I think the reconciliation is based on how strong you are to begin with and how much load you are using for something like a rounded back deadlift. And that’s also based on if you have segmental flexion in the first place.
From an overall partition of training resources, it’s a matter of what is required of you and what you already are exceeding at.
I think training outside of neutral with the purpose of developing directional tissue resiliency becomes more obligatory in recovery from soft tissue injury and athletics that require unique injurious positions for ultimate success.
It’s all a big dance, but where I once thought it was totally wrong, I now find that I was wrong.
Eye-hand/foot coordination, Decision making, Split attention, and Depth perception are all critical pieces to human performance.
They all are tracked through vision.
Measuring them sounds like a good idea, no?
If you wake up in deep sleep, you’re screwed.
If we have technology do determine ideal time to wake up, which we do, that sounds like the best utility.
“Your sport is not different.
You just think it is.”
Looking forward to going to Qatar in October.
I’m not sure who said this, but the line is “Research is history.”
Research gives us backside confirmation as to why things work or don’t work in a typically much less variant-based environment than the real world. Research at times gives us trends to try to reproduce.
Changing pain, changing how individuals perform, winning games are all the matters.
Please don’t assume all Whole-Body Vibration platforms are the same.
Just because you weren’t exposed to other options doesn’t mean yours is the best or even safe.
“Beginners have choices.
Experienced don’t need them.”
It seems like prominent names in training and rehab are seemingly antagonistic, but I think they are often more the same than different.
And I think the antagonism is almost never about collegiate offense, but commercial jealousy.
The problem with stretching is not that it’s bad. It’s that it has so many definitions.
And the most universal definitions are just misapplied.
Passive techniques to create excursion is at times obligatory.
Passive stretching without developing tension throughout the range is a mistake.
There’s actually a growing body of work in the literature attempting to explain if the Bilateral Deficit exists, which it certainly does, and why. I think if we know why, then we can angle exploitations in the program.
It’s interesting to suggest that the BLD is associated with a decrease in fast-twitch fibers.
But no one is looking at real training moves in favor of grip, isokinetic applications, and the sorry leg press. Kuruganti seems to be the name to follow here.
I think there’s room for both unilateral and bilateral training, but ultimately I don’t know that unilateral-only is not the answer. It may very well be.
I remember a few years ago walking from the hotel in Toronto over to the ACC for practice, and Alex McKechnie was either just starting or in his 2nd year with the Raptors.
I remember it quite clearly when he explained his view that we will probably never change things like asymmetry in certain sports, but we should certainly try to combat it.
No one is trying to create symmetry.
There is an ardent attempt to combat asymmetry outside of a certain range.
Here is a brief synopsis to one of my forays in the Q&A with the Chinese Olympic Committee on our last day there.
A young lady asked me how do you decide who the Lead in a High Performance Program.
I said that when you have the right people, whoever is in charge is just the right person to be in charge.
Practically, when structure, like a torn ligament or concussion, is the limiting factor to performance, the medical doctor is the lead with everyone else following.
When joint position is the limiting factor to performance, the PT is the lead with everyone else following.
When fitness is the limiting factor, the fitness or strength coach is the lead with everyone else following.
All else, the technical or skills coach leads, and the science guys position everyone else’s contributions.
When everybody knows that they need each other to dominate the program, this is much easier than it sounds. It all goes back to having the right people.
I cherished many great things apart from the hell of being at MARSOC.
The best line though I learned at MARSOC from the many conversations with our CG, MajGen Paul Lefebrve was, “Sometimes being a good leader is being a good follower.”
This is really not that hard of a concept to embody……………………, when you have the right people in place.
My Core Beliefs:
Stress can be geared to neurological expressions of movement or physiological expressions of capacity. You either change how someone moves, or you help someone jump over buildings. Anything else is a warmup or cooldown.
Before anything else is worthy of evaluation or intervention, there must be some avenue to ensure that joints can get into the ideal position to absorb and adapt to stress.
Only so many things can be limiting factors: Equipment, Technical Skills, Biological Power, or Fundamental Ability to Get Into Positions to Improve.
Performance components house measurement and solutions through Movement, Output, Readiness, and Sensory Systems. I believe how these buckets are populated with tests and interventions is far secondary to a cPositions to Improve.omplete review.
A great plan will always have an intersection of medical, fitness, and science.
Stress can only do 4 things: Change pain, Change mobility, Change Motor Performance, Change Fitness
Your intent or belief to do what you do is correct………………if it’s correct. All that matters is if you made a desirable change.
Injury frequency is the domain of a fitness or S&C program. Medical assists in regular recovery. Science confirms beliefs.
Length of time of injury is the domain of the medical program. Fitness assists in central mechanisms of humeral and hormal effects. Science confirms beliefs.
Reinjury is the everybody’s fault and often the coach or organizational logistics at the root.
Just because you don’t have an epidemic of problems or injury in a particular joint system doesn’t mean it doesn’t warrant review or coaching during training.
Poor position in a joint system can lead to injury elsewhere.
Just because there is no epidemic, that doesn’t mean there’s not a better way to do it.
I remember not being a favorite of my PT School faculty for a number of reasons. I actually almost got thrown out.
One of the issues was the decided slant of the faculty towards neuro and pediatrics, and I was perceived as “set on” being in orthopedics.
Neuro and pediatrics???? Interesting.
How ya like me now?
The more keys on the key ring wins. That includes imaging for psychological contributions to Output and Readiness.
If you are into pain science, and it’s all in your head and what you believe, maybe the twitch does matter when you needle. Maybe it matters when your neck cavitates when you get after it, or more clicks is better than 1 click.
Wouldn’t the tangible nature of a jump sign or cavitation tap into the belief that something is better than nothing in the brain, perhaps the postcingulate gyrus, of the patient?
In using e-stim, it appears targeting tonic muscles require high frequency and phasic muscles require low frequency.
Something not often discussed is that if you are targeting a muscle that is deeper, as tonic muscles are, putting the pads farther apart should yield a deeper intersection of the currents.
It seems like the commercial recovery stim units, which are very useful, do not apply this electrotherapy principle.
Maybe we should look again at the Class IV laser.
I think leaving a soft 1 or asymmetry on the table in the FMS, meaning you just leave it and don’t worry about it changing, is very defensible. The FMS yields information of if the joints can mechanically or neurologically get into the ideal positions to absorb and adapt to stress.
There will be many times that you find this information after deeper screens, and terminal training is capable and competent.
I think many people know this and just can’t or won’t verbalize it.
If I believe the joint position exists to achieve something like ASLR is there, that means I should believe the proprioception to acquire a new motor skill is also competent. Teaching the system to sprint or DL seems a lot more important than budging my score that got me to the right place with just a few extra and needed steps.
When you run Functional Movement System the way it was developed some 20 years ago, you will be able to skip steps and not miss anything. This I believe, and that’s actually my mentor Gray’s, line, not mine.
Expertise is knowing when NOT to do something.
The wild disparities in the safety and clinical foundations of dry needling are very disconcerting.
I’m not experienced enough to know who to believe.
Treating the Abdominal muscles needs to happen more often.
If the Shield is tensioned, it will be challenging to breathe behind it.
This is the Core Pendulum at work.
Taking courses over again is important and something I think we should do more of.
We Forget things, but more importantly even if the information may even be the same, you’re different.
We’re even luckier if the name of the instructor is the same, but he/she is different.
Dunning’s model of Dry Needling is really quite brilliant, and I look forward to his book coming out.
Basically if you take every study in the history of ever using needles that had a positive affect on pain and then just removed the areas of dry needling that don’t make sense to a neuromuscular or biomechanical model (i.e. no needles in the face for turf toe), you’ve got a very powerful and useful model.
There are many ways to Dry Needle.
I was recently at a course where we were asked to introduce ourselves.
One clown admitted he saw 1 patient every 7.5 minutes. The last rationale he gave was that he gets paid based on the amount of people he sees.
I really respected that he admitted that.
And as he went on to speak, I realized there probably wasn’t much I would have in common in talking to him about.
Increased H+, Bradykinin, 5HT, NorEpi, CGRP, Substance P, TNF-alpha, IL-1B, IL-6, IL-8, ACH
But Trigger Points are just a North American cultural phenomenon according to your pain science hero, right?
Be careful in applying neuroceptive inputs that powerfully change acute tension. What if the individual needed that tension to protect against pain?
This is the power of DNS that I believe upregulates tonic function as well.
In reading Bosco’s works, there is a difference in vertical jump testing and lower body power testing.
Are we using the model to test vertical jump as a measure of chronic adaptations and performance, or are we looking for daily readiness or talent identification?
You can teach someone to jump higher to reach something, and even having a target to reach for will yield getting up bigger.
But with hands on hip using a jump mat landing the same spot as you take off has no learning curve and appears to be a much more legitimate test of lower body power, thusly with expectations of carryover and implications of training based on being some level of fast- or slow-twitch.
If that Bosco document wasn’t so damn blurry, PW!!!!
Palpating a taut band is more reliable in the literature than the Travell-based pain referral patterns.
As usual, everybody’s right when you actually are good at treating people.
I don’t think many PTs working in a commercial setting would even know what to do if they had a patient 1-on-1 for an hour.
The first clue is talk to the person.
The patient will say you’re the first person that’s ever listened to them.
Hopefully you’ll just be the first person that actually cared.
Dealing with structural asymmetries must be a very guided battle. I do believe we can change bony structure, but in the adult, it is a very long process.
Deeper Screens and Breakouts in the FMS and SFMA clear as day have these checkpoints built into the model.
When it comes to sport-generated asymmetries or “dysfunctions,” analysis of the system and the sport itself are incumbent. Maybe they are good that they are there, but you also know they are injury mechanisms.
So you live with the FACT that asymmetries are the #2 predictor of injury, and you can Regress to create directional tissue resiliency to those patterns, which seems much easier to fit into the priorities of the program.
You can also Lateralize certain movements that address the same physiological adaptations, but hide if you will, from the structural or stiff asymmetry. It can mean hopping instead of jumping or KB ballistics instead of olympic lifts, or pulling out of the hang above the knee instead of below the knee or the floor.
Using e-stim has polarity (probably biphasic waveform or straight out DC) for recovery with or without needles, the (+) would be used to upregulate or stimulate wound healing. The (-) would be to downregulate or decrease swelling.
Whiplash client with an avulsed nerve root.
Patient is dizzy. Has remarkable FABQ. Fatty infiltrate on US. Increase in sway.
The solutions will lie in the Sensory Systems bucket, and with Canada Basketball, we started using the CAPS Vestibular Technology for this type of potential.
Segmental spinal function clearly affects global erectors.
The Euler and Segmental models are both correct. One just comes first.
An A-P rib technique might be useful in pain that feels like an arrow going through you.
A frontal rotational rib technique may be useful when the pain feels like it wraps around.
The tempermental nature of the T-spine can be confirmed or denied by Autonomic NS measures.
Did what you did work? Or do you just think it worked because your heroes say everything is autonomic? How about actually testing it?
Treating the T-L junction (as well as C-T) is what they teach at Hogwarts on Day 1.
Treating the assumed pathoanatomic diagnosis within a movement-based algorithm is not wrong………..unless you keep doing it and 3x/week, 4 weeks later, nothing has changed.
I think we should be able to prove a pathway to improvement in no more than 2 1-hr sessions.
5% of people have a hole in the infraspinous and supraspinous fossa
A great High Performance Program will
1. Reposition what all team members do well,
2. Expose where the team as a whole needs to improve by changing beliefs, increasing skills set, or incorporating new staff,
3. Generate questions you didn’t know existed, and
4. Generate solutions you didn’t even know you needed.
This is a business leadership model, not a human performance or a professional sports model.
It seems like in human performance a fact is just what a lot of people believe.
You can develop any of your own Deeper Screens or Breakouts with the 4 angles of
1) Loaded vs. Unloaded
2) Active vs. Passive
3) Resisted vs. Bodyweight
4) Assisted vs. Unassisted
Not all of these will be practical for every joint system.
The One Shot, One Kill approach to using the SFMA is really just very steeped in the Chan Gunn IMS model.
The Global Rating of Change Scale looks useful, but with any patient survey as an outcome assessment, the patient has every opportunity to thank you for being nice to them when they were done, for having hot chicks up front, and giving you backsacks with your office’s logo on it.
Any time there is a subjective response in an Outcome Assessment, there will always be tie breakers. Is it an outcome measure, or is it a chance to let a patient say thank you?
If some kind of neuroceptive technique works, and a major change happens, you have cracked a neurological allostatic hold.
It won’t stick. You’ve just opened the window to acquire new motor skills by lifting this “lock.”
There are credible individuals that will suggest exercise after manual therapy is not useful, and they believe there is research to support this.
I think they are correct.
However, most research studies stupid non-stimulative or non-developmental for motor control or fitness, which is what exercise is to most PTs. So it’s not unfair to make statements based on these lines of beliefs.
Glucocorticoids kill hippocampus cells that make memories.
I enjoy reading your thoughts. Thank you. I want to attend a vestibular course. Do you have any great recommendations?